| NPI | 1124491287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 71960) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 71960) |
| 101YP2500X Counselor, Professional (Licence: TX 71960) | |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2019-09-04 |